title: Restorative proctocolectomy for ulcerative colitis: development and validation of a new scoring system for pouch dysfunction and quality of life.
abstract: OBJECTIVE
  The purpose of this study was to develop and validate a pouch dysfunction score that could identify the aspects of function which have the greatest impact on quality of life as perceived by the patient.
  
  
  METHODS
  All (n = 1757) patients having restorative proctocolectomy in Denmark between 1980 and 2010 were identified. Of these, 1229 were available for study and were sent a questionnaire on bowel function and quality of life (QoL) designed specifically for this study. Function was correlated with QoL in a multivariate model using ordinal logistic regression with QoL as a dependent variable. The pouch dysfunction score was developed from a randomly selected half of the study population and the validity was tested on the other half.
  
  
  RESULTS
  1047 (85%) patients returned the questionnaire. On multivariate analysis, the symptom domains of 'incomplete emptying', 'severity of urgency', 'number of bowel movements/24 h', 'major incontinence' and 'use of anti-diarrhoeal medication' were associated with reduced QoL. The score was divided into three categories including 'none', 'minor' and 'some/major' pouch dysfunction. The corresponding coefficients gave the score a range from 0 to 7.5. There was a highly significant difference (P < 0.001) in score between the categories. The area under the receiver operating curve was 0.81.
  
  
  CONCLUSIONS
  Urgency, incomplete emptying, number of bowel movements/24 h, major incontinence and use of anti-diarrhoeal medication have a major impact on QoL. There was a high accuracy for the score, demonstrating its potential clinical usefulness in relating symptoms to QoL.
authors.affiliation: Colorectal Surgical Unit, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Brandsborg
authors.forename: R J
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: L S
authors.initials: LS
authors.lastname: Mortensen
authors.forename: S
authors.initials: S
authors.lastname: Laurberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000930:Antidiarrheals / Q000627:therapeutic use; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D003108:Colonic Diseases / Q000209:etiology; D039021:Colonic Pouches; D003672:Defecation; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000930:Antidiarrheals
keywords: Restorative proctocolectomy; pouch dysfunction; quality of life